Deadly Virus's Spread Raises Alarms in Mideast

Saudis Defend Approach to MERS Outbreak, Even as Cases Increase

By Ellen Knickmeyer and Ahmed Al Omran

April 13, 2014 7:20 p.m. ET

A view of the King Fahd hospital, which has closed its emergency department banning the exit and entry of people and patients, on April 9, in Jeddah, Saudi Arabia. Agence France-Presse/Getty Images

Saudi Arabia on Sunday confirmed a surge of cases of a deadly virus in the kingdom over the past two weeks, even as it tried to counter criticism that it wasn't doing enough to contain the outbreak.

The United Arab Emirates over the weekend separately announced six confirmed cases of Middle East Respiratory Syndrome, or MERS, among paramedics there, one of whom died of the illness. The high number of cases among medical workers raised questions about how effective Arab Gulf governments have been in controlling the 1½-year-old outbreak.

"I'm not pretty sure that they are actually seeing how big this thing is," a Saudi doctor said on Sunday at King Fahd General Hospital, the large public hospital in Jeddah that has been hardest hit by a spike in the city this month.

The hospital reopened its emergency room on Friday after shutting it briefly for what authorities said was disinfection measures against MERS. But patients were avoiding the hospital, and health workers were "very worried" after the MERS death of one colleague and sickness in another, the doctor said. "What I really wish for is to shut the whole hospital down" until the spread subsides, she said.

Last week marked the biggest number of cases since the outbreak began, Dr. Ian M. Mackay, an Australian epidemiologist who has tracked the outbreak, wrote on Sunday. About 50 of the overall cases have been in health-care workers, he said, a strong warning sign about measures being taken to control the outbreak, he and others have said. "As far as we know, MERS-CoV does not spread easily from person-to-person, so these clusters suggest a breakdown in infection prevention and control."

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Saudi Arabia and other Arab Gulf countries have said they are taking adequate measures against infection since the first laboratory-confirmed cases of MERS, which kills largely through respiratory infections, in September 2012. Since then, the WHO says it has confirmed 228 cases, 92 of them fatal.

The number rose sharply this month. In just the four days to last Thursday, Saudi Arabia notified the World Health Organization of 15 new confirmed MERS cases, including two deaths, the WHO posted on its official Twitter account late Sunday.

The Saudi Ministry of Health said late Sunday that government precautions to control the disease were sufficient and up to scientific standards. Ministry of Health officials didn't respond to email and phonerequests to comment on the reason for the surge in cases in health-care workers. The World Health Organization said it couldn't immediately respond to similar questions Sunday evening.

The majority of cases have occurred in Saudi Arabia. Authorities have confirmed other cases as far afield as Europe, all of which were believed linked to the Middle East. Yemen's government on Sunday said it confirmed the first known case there.

Medical studies say camels are at least one host of the virus that causes MERS, though the disease also has been confirmed to spread in limited fashion from person to person.

Saudi health officials said last year that they were requiring all health workers to treat arriving patients with respiratory problems as potential MERS cases, and take precautions against patient-to-nurse exposure. The doctor at the Jeddah hospital said authorities this month gave health workers there infection-control pamphlets and face masks.

Saudi Arabia's health minister, Dr. Abdullah al Rabeea, toured Jeddah hospitals on Saturday. He told reporters that what he saw was "reassuring" and that the number of cases was within a "normal" rate. The ministry announced four more cases, three of them in health workers, hours later.

Seven of the latest infected health workers in the kingdom showed no symptoms but tested positive, health officials said. Another died, one was in intensive care and one was in stable condition, according to the kingdom's ministry of health.

The U.A.E. issued a similar statement this weekend over cases there, including five infected expatriate paramedics who remain in quarantine after the death of their colleague.

On Friday, in place of the cleric giving the weekly sermon, a medical official spoke at one of Jeddah's main mosques to brief listeners about how to avoid transmitting MERS.